Alfredo Luiz Jácomo

Universidade de São Paulo

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Co-Authors

Flávia Emi Akamatsu

Universidade de São Paulo

Flávio Hojaij

Universidade de São Paulo

Mauro Andrade

Universidade de São Paulo

Samir Saleh

Vanderbilt University Medical Center

Ana María Itezerote

Universidade de São Paulo

Carlos Augusto Real Martinez

Universidade São Francisco

Mauro Andrade

Universidade de São Paulo

Walcy Rosólia Teodoro

Universidade de São Paulo

Aldo Junqueira Rodrigues Júnior

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

José Aires Pereira

Universidade São Francisco

Cooperative Institutions

Universidade de São Paulo

171

Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

100

Universidade Brasil

Hospital Universitário da Universidade de São Paulo

Hospital Sírio-Libanês

Centro Universitário das Faculdades Metropolitanas Unidas

Universidade Federal de São Paulo

Hospital São Paulo

Instituto do Câncer do Estado de São Paulo

Universidade Estadual de Campinas (UNICAMP)

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Vagus Nerve's Topography in the Carotid Sheath: preliminary results

The FASEB Journal (2013)

Tatiana Mina Yendo Ana Docko Flávio Carneiro Hojaj Flávia Emi Akamatsu Mauro Andrade

The knowledge of the vagus nerve's location within the carotid sheath is essencial in many surgical contexts, such as thyroidectomy. Intraoperative neuromonitoring may prevent iatrogenic nerve injury. There are only few studies about vagus nerve and its topography in the carotid sheath. This study aims to analyze the variation of the vagus nerve topography and its relation with the common carotid artery and the internal jugular vein, at the infrahyoid region. We dissected 10 carotid sheaths from 5 cadavers and the position of the vagus nerve and its relationship with the common carotid artery and the internal jugular vein were determined. Based on the carotid sheath cross‐section, the location of the vagus nerve was classified in four quadrants: between the common carotid artery and the internal jugular vein, but anterior to the carotid artery's cross section (A), between the common carotid artery and the internal jugular vein, but posterior to the carotid artery's cross‐section (B), posterior and medial to the carotid artery's cross section (C) and posterior and lateral to the internal jugular vein's cross‐section (D). We found 6 vagus nerve in position (A), 1 in position (B), 0 in position (C) and 3 in position (D). The knowledge of variations and their prevalence regarding the position of the vagus nerve as described in this preliminary study may contribute to avoid iatrogenic lesions in cervical surgeries.

Internal jugular vein

Jugular vein

10.1096/fasebj.27.1_supplement.746.5

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Citations (1)

A Rare Pattern of Brachial Artery Variation: Case Report

International Journal of Morphology (2014)

Alfredo Luiz Jácomo Carlos Augusto Real Martinez Samir Saleh Marco Antônio Percope de Andrade Flávia Emi Akamatsu

Unlike the venous system, variations in arterial anatomy are less frequent and most of them affect visceral arteries.In limbs, variations of the brachial artery are the most reported and at least six different patterns have been described so far.The commonest is the superficial brachial artery which lies superficially to the median nerve.Much less prevalent are the high origin of the radial artery (brachioradial artery) or the existence of a doubled brachial artery (accessory brachial artery).We present a previously undescribed pattern of brachial artery variation.During dissection of the right upper limb of a 60 year-old male embalmed cadaver, we found the bifurcation of the brachial artery in the proximal portion of the middle third of the arm.Its medial branch reaches the medial aspect of the arm, posterior to the median nerve.Afterwards, this medial branch redirects laterally and crosses again the median nerve, this time lying anterior to the nerve until it reaches the lateral aspect of the arm.At the elbow level, the medial branch originates the radial artery.The lateral branch of the brachial artery remains lateral to the median nerve and continues as ulnar artery and originates the interosseus artery.

10.4067/s0717-95022014000200027

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Empreendedorismo em saúde: relato de um modelo de Empresa Júnior em Medicina

Revista de Medicina (2015)

Sara Terrim Adler Araújo Ribeiro Melo Alfredo Luiz Jácomo

O ensino da medicina Brasil afora é marcado pelo pouco interesse dos acadêmicos pelo tema de gestão em saúde no ensino superior. O reflexo disso são as inúmeras afrontas feitas diariamente à saúde nacional, devido ao mau gerenciamento de recursos públicos e privados, como tanto se vê em clínicas e hospitais atualmente. Tais problemas apresentam como uma de suas causas, entre tantas outras, a falta de conhecimento técnico por parte daqueles que assumem o poder administrativo na área da saúde, muitas vezes escolhidos por suas habilidades assistenciais e conhecimentos médicos, ao invés de por verdadeiro conhecimento e mérito gerencial. Nesse contexto, a Medicina Jr. surgiu como uma iniciativa estudantil a fim de aproximar os universitários da Faculdade de Medicina da Universidade de São Paulo do universo da gestão, apresentando-lhes a área e despertando o interesse para tal assunto tão pouco comentado nos currículos formais. Nasceu assim a ideia de unir os impactos positivos trazidos pela prática de atividades extra-curriculares ao ensino de gestão no ambiente universitário, na expectativa de contribuir para a formação de novos profissionais mais abertos ao tema e com maior conhecimento na área.

10.11606/issn.1679-9836.v94i2p94-98

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<p>Anatomical Study of the Innervation of the Masseter Muscle and Its Correlation with Myofascial Trigger Points</p>

Journal of Pain Research (2020)

Roberto Procópio Pinheiro Matheus Aquesta Gaubeur Ana María Itezerote Samir Saleh Flávio Hojaij

Myofascial pain syndrome (MPS) is widely prevalent in the general population; some reports estimate its prevalence ranges from 9 to 85%. Among the different locations where MPS may arise, pain related to the masseter muscle is referred as masticatory myofascial pain. MPS is characterized by myofascial trigger points (MTPs), which represent tender anatomical areas of a muscle where painful symptoms are elicited whenever stimulated. Previous publications have found MTPs to coincide with neuromuscular junctions at the motor end plate, at the innervation zone (IZ). Our study aimed to describe the innervation of the masseter muscle and relate it to clinically described myofascial trigger points (MTPs).We mapped the nerve fiber distribution into the masseter muscles from 16 cadavers by anatomical dissection. We divided the muscle into six regions, three superior (I-III) and three inferior (IV-VI), and classified the nerve's branches distribution according to these predetermined areas. Statistical analyses was made by Poisson distribution and logarithm link function followed by Bonferroni multiple comparisons (P<0.05).All six areas received branches from the masseteric nerve. Areas I and II (upper posterior and upper intermediate, respectively) had a significant higher number of nerve entries as compared to the remaining areas.The penetration areas of the masseteric nerve have been established and MTPs are found in the innervation zones, clinicians should focus initially on the regions of the penetration points, for diagnostics and therapeutic measures, such as injections, dry needling and soft tissue interventions. Anatomical study of nerve supply to the masseter muscle can provide useful additional knowledge to further understanding masticatory myofascial pain and to direct therapeutic interventions and diagnostic studies of temporomandibular junction dysfunction.

Myofascial pain syndrome

Myofascial release

Gross anatomy

Myofascial pain

Dry Needling

10.2147/jpr.s265717

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Citations (14)

Colonic mucosae is affected by experimental gastric restriction

The FASEB Journal (2020)

Flávia Emi Akamatsu Luiz Gustavo Fontes Ana María Itezerote Samir Saleh Flávio Hojaij

Background Obesity‐related comorbidity is defined as a condition caused by overweight/obesity or known to contribute to the presence or severity of the condition. These comorbid conditions are expected to improve or go into remission in the presence of effective and sustained weight loss. World Health Organization reports obesity as a rising chronic condition with many devastating health consequences. Gastric reduction procedures are currently employed to treat morbid obesity and there are few reports concerning the consequent effects in large intestine. Methods Experimental model of gastric restriction was devised using rats. The animals were submitted to surgical gastrostomy and a cylindrical loofah was inserted into the stomach. We studied 30 adult male Wistar rats divided in three groups: the stomach reduction group (R20), the sham group (SH20), which underwent the same procedure except for the loofah insertion and the control group (C20). Animals were fed and kept in separate cages. Sections of the colon were obtained and stained with hematoxylin‐eosin and analyzed for the length of the crypts, mucous cells and inflammatory cells. Goblet cells and inflammatory cells were obtained in all groups as mean, median, minimum and maximum and were compared between groups using generalized estimation equations (GEE) with normal distribution and identity link function supposing exchangeable correlation matrix between fields. Bonferroni’s multiple comparison was applied to identify differences between groups. The results are described by the mean value with respective standard deviation. Results The analysis of Goblet cells count on R20 group indicated a statistically significant reduction and shallower crypts as compared to the C20. There was a significant difference regarding inflammatory cells on R20 compared to C20 and SH20. Polymorphonuclear inflammatory cells were increased in all groups when compared to lymphomononuclear cell but with no significant difference among groups. Conclusion These findings might be a result of colonic mucosae atrophy secondary to the effects of gastric restriction in this model. The increase in neutrophil infiltrate may be related to the presence of bezoar, as well as the greater aggression to the colic epithelium due to lack of short chain fatty acids (CCFA), oxidative stress epithelial damage due to lack of CCFA.

Goblet cell

Eosin

Gee

10.1096/fasebj.2020.34.s1.01925

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Corona Mortis: A Systematic Review of Literature

Clinics (2021)

Giovana Irikura Cardoso Lucas Albuquerque Chinelatto Flávio Hojaij Flávia Emi Akamatsu Alfredo Luiz Jácomo

0 0 0 -0 0 0 0 -0 0 0 0 , I, * Lucas Albuquerque Chinelatto0 0 0 0 -0 0 0 0 -0 0 0 0 -0 0 0 0 , II Flavio Hojaij0

Rigor mortis

SciELO

10.6061/clinics/2021/e2182

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Citations (12)

Trigger Points: An Anatomical Substratum

BioMed Research International (2015)

Flávia Emi Akamatsu Bernardo Rodrigues Ayres Samir Saleh Flávio Hojaij Mauro Andrade

This study aimed to bring the trapezius muscle knowledge of the locations where the accessory nerve branches enter the muscle belly to reach the motor endplates and find myofascial trigger points (MTrPs). Although anatomoclinical correlations represent a major feature of MTrP, no previous reports describing the distribution of the accessory nerve branches and their anatomical relationship with MTrP are found in the literature. Both trapezius muscles from twelve adult cadavers were carefully dissected by the authors (anatomy professors and medical graduate students) to observe the exact point where the branches of the spinal accessory nerve entered the muscle belly. Dissection was performed through stratigraphic layers to preserve the motor innervation of the trapezius muscle, which is located deep in the muscle. Seven points are described, four of which are motor points: in all cases, these locations corresponded to clinically described MTrPs. The four points were common in these twelve cadavers. This type of clinical correlation between spinal accessory nerve branching and MTrP is useful to achieve a better understanding of the anatomical correlation of MTrP and the physiopathology of these disorders and may provide a scientific basis for their treatment, rendering useful additional information to therapists to achieve better diagnoses and improve therapeutic approaches.

Trapezius muscle

Gross anatomy

Accessory nerve

Myofascial pain syndrome

10.1155/2015/623287

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Citations (37)

Lymph Drainage of the Upper Limb and Mammary Region to the Axilla. Anatomical Study in Stillbirths

The FASEB Journal (2015)

Guilherme de Arruda Cuadrado Mauro Andrade Flávia Emi Akamatsu Alfredo Luiz Jácomo

The aim of this study was to investigate the lymphatic pathways of the upper limb and the breast in the axillary region to evaluate the occurrence of anastomoses and shared drainage, assessing the safety of the Axillary Reverse Mapping (ARM) to preserve arm lymph nodes in breast cancer treatment. Modified Gerota mass was injected intradermally in the periareolar area, the palm and back of the hand of unfixed stillbirths. They were submerged in H₂O₂ before microsurgical dissection of the superficial fascia of the upper limb, the axillary region and the anterior thorax to expose the lymphatic pathways. It was approved by the the Ethics Committee nº 134/13. We observed the dye injected in the upper limb reached either the lateral group, referred as the major area related to the upper limb, or the anterior group, which is tipically related to breast drainage. It was found great proximity among the pathways and the lymph nodes, besides communicating lymphatic vessels among the breast and upper limb lymph nodes in all studied cases. ARM is an alternative to avoid postoperative lymphedema, but, despite possible anatomical changes during growth, it seems ARM should be further studied before implementation in clinical practice for it may present potential oncological risks because the preserved lymph nodes may harbor malignant cells due to lymph nodes proximity, overlapping drainage and connecting lymph vessels among lymph nodes.

Axilla

Axillary lymph nodes

10.1096/fasebj.29.1_supplement.552.12

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Polyethylene glycol fusion associated with antioxidants: A new promise in the treatment of traumatic facial paralysis

Head & Neck (2018)

Raquel Salomone Alfredo Luiz Jácomo Silvia Nascimento Karina Lezirovitz Flávio Hojaij

Abstract Background Recent studies in invertebrates have taught us that early cell membrane regeneration is determinant for axonal recovery and survival after trauma. Many authors obtained extraordinary results in neural regeneration using polyethylene glycol fusion protocols, which also involved microsutures and antioxidants. Methods Sixty rats were evaluated with functional and histological protocol after facial nerve neurotmesis. Groups A and B had their stumps coapted with microsuture after 24 hours of neurotmesis and groups C and D after 72 hours. In addition to the microstructure, groups B and D used the polyethylene glycol‐fusion protocol for the modulation of the Ca +2 . Results At the sixth week, the latency of group D and duration of group B was lower than groups A and C ( P = .011). The axonal diameter of the groups that used polyethylene glycol‐fusion was higher than those who did not use polyethylene glycol‐fusion ( P ≤ .001). Conclusion Although not providing a functional improvement, polyethylene glycol‐fusion slowed down demyelination.

10.1002/hed.25122

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Citations (15)

Aderência intertalâmica e Alzheimer

Revista de Medicina (2019)

Mikhael Belkovsky Isabela C. B. Souza Flávia Emi Akamatsu Flávio Hojaij Alfredo Luiz Jácomo

OBJETIVO: Descrever dimensões e prevalência da Aderência Intertalâmica (AI) em cadáveres do Serviço de Verificação de Óbitos da Capital - USP, considerando idade, sexo, peso, altura e histórico pessoal de doença de Alzheimer (DA). MÉTODOS: Cinquenta e sete cadáveres (31H/26M) foram incluídos no estudo, com média de idade de 66,2 anos (variando entre 15 e 91 anos). A análise da AI foi feita após secção transversal da calota craniana e incisão axial no limite inferior do tronco encefálico seguida de retirada do encéfalo de sua cavidade. Cinquenta e quatro encéfalos foram submetidos a incisão sagital mediana, dois encéfalos foram submetidos a cortes axiais, e um encéfalo a secção coronal. Dados quantitativos foram comparadas pelo teste t de student, e dados qualitativos pelo teste de Qui Quadrado. A análise idade vs área foi feita por regressão linear. RESULTADOS: A prevalência de AI foi de 79%, não havendo diferença significativa entre os sexos (p=0,68). Observou-se associação entre menores áreas de secção sagital e idades mais avançadas (p=0,02). Não houve diferença significativa na prevalência de AI nem na área de secção transversal em pacientes com DA. DISCUSSÃO: Ao contrário de estudos prévios, que associaram maior prevalência e tamanho de AI com sexo feminino, isso não foi observado em nossa casuística. Apesar de não ser estatisticamente significativa nota-se uma diferença importante nas áreas médias de secção sagital dos grupos com e sem DA, o que aponta para a necessidade de estudos subsequentes com amostras maiores.

10.11606/issn.1679-9836.v98i4p254-258

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